Intracranial Aneurysms in the Pediatric Population: Case Series

Abstract

Introduction: Aneurysms are rare in the pediatric population and its diagnosis can be challenging. They differ from their adult counterparts in several aspects, and hemorrhage is the most frequent presentation. Objective: To evaluate clinical data, aneurysms characteristics and therapeutic results in a series of patients <18 years of age with intracranial aneurysms. Method: A retrospective cross-sectional observational study design through the analysis of medical records and imaging studies. Analyzed data included age, sex, presentation, comorbidities, aneurysmal characteristics, treatment modality and clinical outcomes. Results: 15 intracranial aneurysms were identified in 11 patients (6 male), with ages ranging from 3 months to 15 years (mean 5.2 years). Five patients had associated medical conditions, and hemorrhage was the most frequent clinical presentation (45%). Three patients (27%) had multiple aneurysms, and 7 aneurysms were fusiform or dysplastic. The internal carotid artery was the most affected site, occurring in 47% of cases. Aneurysm size ranged from 2 mm to 60 mm (mean 16.8 mm), with giant aneurysms in 27%. Seven patients were treated via endovascular procedures and three aneurysms were clipped. Symptomatic vasospasm requiring angioplasty occurred in two patients. One patient died due to severe aspiration pneumonia and sepsis that precluded treatment. Good functional outcome (mRS < 2) was achieved in all patients submitted to treatment (91%). Conclusion: The patients with aneurysms in this series were characterized by hemorrhagic presentation, mild male predominance, and internal carotid artery involvement. The outcome of treated patients was favorable, regardless of the treatment modality.